Over one-fifth of teenagers in India at moderate-to-high risk of substance use: Study

Over one-fifth of teenagers in India may be at moderate-to-high risk of substance use, according to a study of more than 6,000 adolescents across 108 schools in six districts.

Published in The Lancet Regional Health-Southeast Asia, the study found that 21.4 per cent of adolescents were at moderate or high risk of substance use, with 10.3 per cent at moderate risk and 11.1 per cent at high risk. The remaining 78.6 per cent were classified as low risk.

The study was conducted in government and private schools across Gorakhpur in Uttar Pradesh, Kamrup in Assam, Nagpur in Maharashtra, Rajkot in Gujarat, Deoghar in Jharkhand and Puducherry.

Schools in Guwahati and Deoghar had the highest proportions of adolescents in the high- and moderate-risk categories, while those in Nagpur and Puducherry had predominantly low-risk profiles.

The researchers found that higher digital exposure and more favourable attitudes towards substance use were associated with elevated risk. Accessibility to substances and risky behavioural environments were also identified as key modifiable factors, while social engagement appeared to have a protective effect.

The researchers assessed substance use risk using the World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), while personality traits were assessed using the Substance Use Risk Profile Scale.

The study found a 35.1 percentage point gap in substance use risk between Guwahati and Nagpur, with nearly 40 per cent of the difference explained by factors including school characteristics, socio-economic and demographic factors, and personality traits.

The researchers said the findings highlighted the role of contextual environments in shaping substance use risk among teenagers and called for prevention strategies that go beyond general awareness campaigns.

They recommended context-specific, multi-level interventions, including stronger regulatory enforcement to reduce access to substances, media literacy initiatives to address digital exposure and peer-led programmes under the School Health Programme.